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Health Care Reform:

Health Insurance & Affordable Care Act

Medicare and Long-Term Care

Some people assume that Medicare will cover long-term care, like care in a nursing home. But in reality, it doesn't cover much long-term care. So if you're planning for yourself, or caring for an older relative, here's what you need to know.

Understanding Medicare Coverage

  • Medicare covers short-term recovery from an illness or injury. If you need time in a nursing facility to recover from a stroke, or a broken bone, Medicare should pay some of the costs. Then, once you're better -- or the allotment runs out -- the coverage stops.
  • Medicare does not cover indefinite, long-term care. Medicare does not have coverage for people who need to go into nursing homes indefinitely because they are disabled or can no longer take care of themselves. Medicare also does not cover assisted living or adult daycare.
  • Medicare does not cover daily custodial care, such as assistance with eating, bathing and dressing.

 

What Types of Care Does Medicare Cover?

  • Skilled Nursing Care. Medicare helps to pay for your recovery in a skilled nursing care facility after a three-day hospital stay. Medicare will cover the cost of skilled nursing care for a maximum of 100 days (although most people need much less than that). As soon as you no longer need daily skilled nursing care, Medicare stops paying.
  • Home Health Care. If you are homebound by an illness or injury, and your doctor says you need short-term skilled care, Medicare will pay for nurses and therapists to provide services in your home. This is not around-the-clock care. Generally, it's for no more than 35 hours per week (although again, most people get much less than that). With your doctor's recommendation, you may qualify for more.
  • Hospice. Medicare covers hospice care. Hospice is care you get to make you more comfortable when you are in the last stage of life with a terminal illness. You're eligible if you are not being treated for your terminal illness, and your doctor certifies that you probably will live no longer than six months. You can get care for longer than that as long as your doctor says you are still terminally ill.

If Medicare Won't Pay for Long-Term Care, What Should I Do?

Long-term care can be tremendously expensive, and unfortunately, your options for covering it are limited. So what are they?

One is to rely on your own savings or a loan, like a reverse mortgage.

Another is to buy long-term care insurance, which is sold by many insurance companies. The earlier you buy a policy, the better. The premium gets more expensive the older you are. You may also be able to trade in your life insurance policy for long-term care insurance. People who have worked for the government or were in the military may qualify for discounted insurance.

If your income or assets are low enough -- the cut-off number varies from state to state -- you might qualify for Medicaid, which will cover most of your long-term care costs. If you have Medicare and Medicaid both, most of your health costs should be covered. Some states also offer PACE (Programs of All-inclusive Care for the Elderly) through Medicaid. These programs, for people who are sick or very frail, may also cover some of your costs.

Many people who don't qualify for Medicaid because their assets are too high pay for long-term care on their own. Then, once that money is exhausted, and their assets are low enough, they can then qualify for Medicaid coverage.

Medicaid programs are run by individual states. The Benefits.gov web site should be able to connect you to information about your state's Medicaid plan.

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